Managing patients requiring Ebola assessment guideline

Key messages for primary care:

Assessment of a patient’s risk of Ebola should be led by the hospital medical team. However, such patients may present initially to primary care and therefore primary care clinicians need to be aware of how to safely assess such patients and refer them appropriately to the local acute trust for review

All suspected Ebola cases that present to primary care should be discussed by the primary care clinician with the local infection specialist (consultant microbiologist, virologist or infectious disease physician) who will lead the risk assessment and arrange clinical review

Specific local advice (including local arrangements for contacting your local infection specialist) can be obtained from your local PHE health protection team; find your local team using the postcode lookup, which gives both in hours and out of hours contact details

Individuals that telephone the surgery or walk-in centre and report that they are unwell and have visited an affected area in the past 21 days AND report a fever of ≥37.5°C or fever within the past 24 hours must be told not to visit the surgery or walk-in centre. The patient should be called back as soon as possible by the GP or duty doctor to risk assess prior to discussion with the local infection specialist

Surgeries, out of hours centres and walk-in centres should clearly display information requesting patients to tell the receptionist on arrival if they are unwell and have returned from an Ebola-affected area within the last 21 days. Any patients identifying themselves to reception staff should not sit in the general waiting room once Ebola is considered a possibility. These patients should be isolated in a single side room immediately to limit contact, and urgent clinical advice sought from the local infection specialist

If at the time of a consultation it becomes apparent that Ebola may be a possibility then the attending primary care clinician should take immediate steps to isolate the patient to limit further contact and seek advice from the local infection specialist. Hand hygiene is an important infection control measure. The Ebola virus is not a robust virus and is readily inactivated, for example, by soap and water or by alcohol. It is important to remember that transmission of Ebola from person to person is only through direct contact with the blood or body fluids of a symptomatic infected person. There is no evidence of Ebola transmission through intact skin or through small droplet spread, such as coughing or sneezing

If a patient is being transferred to hospital, it is essential to alert the ambulance service and the hospital to the possibility of Ebola, as they will need to put special precautions in place to ensure the vehicle and personal protective equipment (PPE) are appropriate to the condition of the patient

Cleaning and decontamination of any rooms in which a suspected or confirmed Ebola patient has been isolated or any facilities used by the patient should be discussed with the local health protection team. In the event of a case being confirmed identification and follow up of contacts will be undertaken by the local health protection team